Parents bring their 6-month-old son worried that he 'looks cross-eyed'. The corneal light reflexes are symmetrically centred in both pupils, cover testing reveals no shift, and there are prominent bilateral epicanthal folds. What is the most likely explanation?
- A Intermittent accommodative esotropia awaiting spectacles
- B Pseudostrabismus due to epicanthal folds ✓
- C Microtropia with identity
- D Congenital sixth nerve palsy with compensatory fixation
Correct answer: B. Pseudostrabismus due to epicanthal folds
Explanation
Prominent epicanthal folds, common in Asian infants, cover the nasal sclera and create the illusion of esotropia although the corneal light reflexes are centred and cover testing shows no movement. This is pseudoesotropia, which resolves as the nasal bridge develops. The centred symmetrical Hirschberg reflexes directly exclude a true deviation, killing option A, and microtropia or sixth nerve palsy would produce measurable shifts on cover testing.
Reference: Parsons' Diseases of the Eye, 23rd ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.